[MCQ] Electrocardiography- Part 2

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Electrocardiography- Part 2

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Question 1

The normal atrial depolarization vector is oriented ?

A	Downward and toward left
B	Upward and toward left
C	Downward and toward right
D	Upward and toward right

Question 1 Explanation:

Normal atrial depolarization vector (P wave) is oriented downward & toward left, indicating spread of depolarization from sinus node to right & then left atrial myocardium. Since this vector points toward the negative pole of lead aVR, normal P wave will be negative in aVR. Opposite will occur if an ectopic pacemaker is in the lower part of either atrium or in the AV junction region

Question 2

QRS vector 1 points towards ?

A	Leftward and posteriorly
B	Leftward and anteriorly
C	Rightward and posteriorly
D	Rightward and anteriorly

Question 3

QRS vector 2 points towards ?

A	Leftward and posteriorly
B	Leftward and anteriorly
C	Rightward and posteriorly
D	Rightward and anteriorly

Question 3 Explanation:

QRS complex represents depolarization of ventricles. Its first phase (vector 1) is depolarization of interventricular septum from left to right & anteriorly. Second phase (vector 2) results from the simultaneous depolarization of right & left ventricles that points leftward & posteriorly due to the more massive left ventricle

Question 4

Above what degree of QRS axis is left axis deviation defined ?

A	– 10º
B	– 20º
C	– 30º
D	– 30º

Question 5

Above what degree of QRS axis is called right axis deviation ?

A	+ 80º
B	+ 90º
C	+ 100º
D	+ 110º

Question 5 Explanation:

Normally, the QRS axis ranges from –30º to +100º. QRS axis more negative than – 30º is referred to as left axis deviation, while an axis more positive than + 100º is referred to as right axis deviation.

Question 6

Left axis deviation occurs in ?

A	As a normal variant
B	Left ventricular hypertrophy
C	Inferior myocardial infarction
D	All of the above

Question 6 Explanation:

Left axis deviation may occur as a normal variant but is more commonly associated with left ventricular hypertrophy, left anterior fascicular hemiblock, or inferior myocardial infarction

Question 7

Right axis deviation occurs in ?

A	Due to reversal of left and right arm electrodes
B	Right ventricular overload
C	Infarction of lateral wall of left ventricle
D	All of the above

Question 8

Right axis deviation (RAD) occurs in ?

A	Dextrocardia
B	Left pneumothorax
C	Left posterior hemiblock
D	All of the above

Question 8 Explanation:

All of the above

Question 9

An abnormal increase in U-wave amplitude is due to which of the following drugs ?

A	Quinidine
B	Procainamide
C	Disopyramide
D	All of the above

Question 10

An abnormal increase in U-wave amplitude is due which of the following electrolyte disturbance ?

A	Hyponatremia
B	Hyperkalemia
C	Hypokalemia
D	All of the above

Question 10 Explanation:

Abnormal increase in U-wave amplitude is mostly due to hypokalemia or drugs like dofetilide, amiodarone, sotalol, quinidine, procainamide, disopyramide

Question 11

Very prominent U waves are a marker of increased susceptibility to which of the following ?

A	Torsades de pointes (TDP)
B	AIVR
C	Ventricular flutter
D	Any of the above

Question 11 Explanation:

Very prominent U waves are a marker of increased susceptibility to TDP type of ventricular tachycardia. Inversion of U wave in precordial leads is abnormal & may be a subtle sign of ischemia.

Question 12

P wave amplitude of how many millimeter suggests right atrial overload ?

A	>=1.0 mm
B	>=1.5 mm
C	>=2.0 mm
D	>=2.5 mm

Question 12 Explanation:

Right atrial overload (acute or chronic) may lead to an increase in P wave amplitude (>=2.5 mm)

Question 13

Ventricular “strain” pattern is due to which abnormality in hypertrophied muscle ?

A	Depolarization
B	Repolarization
C	Repolarization & depolarization
D	None of the above

Question 13 Explanation:

Ventricular “strain” pattern is due to repolarization abnormalities in hypertrophied muscle

Question 14

Which of the following is not a common feature in right ventricular hypertrophy due to pressure load ?

A	R >= S wave in lead V1
B	Right axis deviation
C	Incomplete or complete right bundle branch block pattern
D	Incomplete or complete right bundle branch block pattern

Question 14 Explanation:

Incomplete or complete right bundle branch block pattern

Question 15

In acute cor pulmonale due to pulmonary embolism, which of the following is the most common arrhythmia ?

A	Sinus tachycardia
B	Atrial fibrillation
C	Atrial flutter
D	PSVT

Question 15 Explanation:

Acute cor pulmonale due to pulmonary embolism may be associated with a normal ECG. Sinus tachycardia is the most common arrhythmia. Atrial fibrillation or flutter may occur

Question 16

S1Q3T3 pattern is seen in ?

A	Acute cor pulmonale due to pulmonary embolism
B	Right bundle branch block
C	Severe mitral stenosis
D	Acute dissection of aorta

Question 16 Explanation:

S1Q3T3 pattern i.e. prominence of S wave in lead I, Q wave in lead III, T-wave inversion in lead III, is seen in acute cor pulmonale due to pulmonary embolism.

Question 17

Poor R-wave progression seen in chronic cor pulmonale due to obstructive lung disease is due to ?

A	Hyperaeration of lungs
B	Downward displacement of diaphragm and heart
C	Myocardial ischemia
D	All of the above

Question 17 Explanation:

Poor R-wave progression is noted in chronic cor pulmonale due to obstructive lung disease despite right ventricular hypertrophy. This is due to downward displacement of diaphragm and heart. Low-voltage complexes are commonly present, owing to hyperaeration of the lungs

Question 18

In ECG, SV1 + (RV5 or RV6)>=35 mm or (RV5 or RV6)>=25 mm indicates ?

A	Right ventricular hypertrophy
B	Left ventricular hypertrophy
C	Left ventricular hypertrophy
D	None of the above

Question 18 Explanation:

SV 1 + (RV5 or RV6) >= 35 mm or (RV5 or RV6) >= 25 mm indicate LVH by voltage criteria.

Question 19

In ECG, RaVL>=11 to 13 mm, RaVF>=20 mm or R1 + SIII>=25 mm indicates ?

A	Right ventricular hypertrophy
B	Left ventricular hypertrophy
C	Biventricular hypertrophy
D	None of the above

Question 19 Explanation:

RaVL >= 11 to 13 mm, RaVF >= 20 mm, R1+SIII >= 25 mm, with or without increased precordial voltage, indicates left ventricular hypertrophy.

Question 20

Which of the following statements about left ventricular hypertrophy (LVH) is false ?

A	Left atrial abnormality increases likelihood of underlying LVH
B	LVH often progresses to incomplete or complete LBBB
C	Sensitivity of conventional voltage criteria for LVH is decreased in thin persons
D	ECG evidence of LVH is a marker of sudden cardiac death

Question 20 Explanation:

Presence of left atrial abnormality increases the likelihood of underlying LVH. LVH often progresses to incomplete or complete LBBB. Sensitivity of conventional voltage criteria for LVH is decreased in obese persons & in smokers. ECG evidence for LVH is a major noninvasive marker of increased risk of cardiovascular morbidity & mortality, including sudden cardiac death.

Question 21

Which of the following about bundle branches is true ?

A	Which of the following about bundle branches is true ?
B	Left is a broad sheet of fibers & right is narrow & cable-like
C	Left & right bundle branches are broad sheets of fibers
D	Left & right bundle branches are narrow & cable-like

Question 21 Explanation:

Bundle of His gives rise to a broad sheet of fibers that course over the left side of interventricular septum to form left bundle branch & a narrow cable-like structure on the right side that forms the right bundle branch

Question 22

With complete bundle branch blocks the QRS interval is ?

A	>= 90 ms in duration
B	>= 100 ms in duration
C	>= 110 ms in duration
D	>= 120 ms in duration

Question 22 Explanation:

With complete bundle branch blocks the QRS interval is >=120 ms in duration. With incomplete blocks, the QRS interval is between 100 and 120 ms.

Question 23

In RBBB, the terminal QRS vector is oriented ?

A	In RBBB, the terminal QRS vector is oriented ?
B	In RBBB, the terminal QRS vector is oriented ?
C	Posteriorly and to right
D	Posteriorly and to left

Question 23 Explanation:

In bundle branch blocks, QRS vector is oriented in the direction of myocardial region where depolarization is delayed. In RBBB, the terminal QRS vector is oriented anteriorly and to the right (rSR´ in V1 & qRS in V6)

Question 24

In LBBB, the major QRS vector is oriented ?

A	Anteriorly and to right
B	Anteriorly and to left
C	Posteriorly and to right
D	Posteriorly and to right

Question 24 Explanation:

Posteriorly and to right

Question 25

Which of the following about bundle branch blocks is false ?

A	Without structural heart disease, LBBB is more common than RBBB
B	Bundle branch blocks may be chronic or intermittent
C	Bundle branch block may be rate-related
D	LBBB pattern is seen in electronic right ventricular pacing

Question 25 Explanation:

In subjects without structural heart disease, RBBB is seen more commonly than LBBB

Question 26

Left bundle branch block is often a marker of ?

A	Ischemic heart disease
B	Ischemic heart disease
C	Cardiomyopathy
D	All of the above

Question 26 Explanation:

LBBB is a marker of increased risk of cardiovascular morbidity & mortality (coronary heart disease, hypertensive heart disease, aortic valve disease, and cardiomyopathy)

Question 27

Examples of bifascicular block include ?

A	RBBB and LPHB
B	RBBB and LPHB
C	RBBB and LPHB
D	All of the above

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See all quizzes of the Electrocardiography at here:

Electrocardiography- Part 1 | Electrocardiography- Part 2 | Electrocardiography- Part 3

1. The normal atrial depolarization vector is oriented ?
A. Downward and toward left
B. Upward and toward left
C. Downward and toward right
D. Upward and toward right

2. QRS vector 1 points towards ?
A. Leftward and posteriorly
B. Leftward and anteriorly
C. Rightward and posteriorly
D. Rightward and anteriorly

3. QRS vector 2 points towards ?
A. Leftward and posteriorly
B. Leftward and anteriorly

C. Rightward and posteriorly
D. Rightward and anteriorly

4. Above what degree of QRS axis is left axis deviation defined ?
A. – 10º
B. – 20º
C. – 30º
D. – 40º

5. Above what degree of QRS axis is called right axis deviation ?
A. + 80º
B. + 90º
C. + 100º
D. + 110º

6. Left axis deviation occurs in ?
A. As a normal variant
B. Left ventricular hypertrophy
C. Inferior myocardial infarction
D. All of the above

7. Right axis deviation occurs in ?
A. Due to reversal of left and right arm electrodes
B. Right ventricular overload
C. Infarction of lateral wall of left ventricle
D. All of the above

8. Right axis deviation (RAD) occurs in ?
A. Dextrocardia
B. Left pneumothorax
C. Left posterior hemiblock
D. All of the above

9. An abnormal increase in U-wave amplitude is due to which of the following drugs ?
A. Quinidine
B. Procainamide
C. Disopyramide
D. All of the above

10. An abnormal increase in U-wave amplitude is due which of the following electrolyte disturbance ?
A. Hyponatremia
B. Hyperkalemia
C. Hypokalemia
D. All of the above

11. Very prominent U waves are a marker of increased susceptibility to which of the following ?
A. Torsades de pointes (TDP)
B. AIVR
C. Ventricular flutter
D. Any of the above

12. P wave amplitude of how many millimeter suggests right atrial overload ?
A. >=1.0 mm
B. >=1.5 mm
C. >=2.0 mm
D. >=2.5 mm

13. Ventricular “strain” pattern is due to which abnormality in hypertrophied muscle ?
A. Depolarization
B. Repolarization
C. Repolarization & depolarization
D. None of the above

14. Which of the following is not a common feature in right ventricular hypertrophy due to pressure load ?
A. R >= S wave in lead V1
B. Right axis deviation
C. Incomplete or complete right bundle branch block pattern
D. ST depression, T-wave inversion in (R) to midprecordial leads

15. In acute cor pulmonale due to pulmonary embolism, which of the following is the most common arrhythmia ?
A. Sinus tachycardia
B. Atrial fibrillation

C. Atrial flutter
D. PSVT

16. S1Q3T3 pattern is seen in ?
A. Acute cor pulmonale due to pulmonary embolism
B. Right bundle branch block
C. Severe mitral stenosis
D. Acute dissection of aorta

17. Poor R-wave progression seen in chronic cor pulmonale due to obstructive lung disease is due to ?
A. Hyperaeration of lungs
B. Downward displacement of diaphragm and heart
C. Myocardial ischemia
D. All of the above

18. In ECG, SV1 + (RV5 or RV6)>=35 mm or (RV5 or RV6)>=25 mm indicates ?
A. Right ventricular hypertrophy
B. Left ventricular hypertrophy
C. Biventricular hypertrophy
D. None of the above

19. In ECG, RaVL>=11 to 13 mm, RaVF>=20 mm or R1 + SIII>=25 mm indicates ?
A. Right ventricular hypertrophy
B. Left ventricular hypertrophy
C. Biventricular hypertrophy
D. None of the above

20. Which of the following statements about left ventricular hypertrophy (LVH) is false ?
A. Left atrial abnormality increases likelihood of underlying LVH
B. LVH often progresses to incomplete or complete LBBB
C. Sensitivity of conventional voltage criteria for LVH is decreased in thin persons
D. ECG evidence of LVH is a marker of sudden cardiac death

21. Which of the following about bundle branches is true ?
A. Left is narrow & cable-like, right is a broad sheet of fibers
B. Left is a broad sheet of fibers & right is narrow & cable-like
C. Left & right bundle branches are broad sheets of fibers
D. Left & right bundle branches are narrow & cable-like

22. With complete bundle branch blocks the QRS interval is ?
A. >= 90 ms in duration
B. >= 100 ms in duration
C. >= 110 ms in duration
D. >= 120 ms in duration

23. In RBBB, the terminal QRS vector is oriented ?
A. Anteriorly and to right
B. Anteriorly and to left
C. Posteriorly and to right
D. Posteriorly and to left

24. In LBBB, the major QRS vector is oriented ?
A. Anteriorly and to right
B. Anteriorly and to left
C. Posteriorly and to right
D. Posteriorly and to left

25. Which of the following about bundle branch blocks is false ?
A. Without structural heart disease, LBBB is more common
than RBBB
B. Bundle branch blocks may be chronic or intermittent
C. Bundle branch block may be rate-related
D. LBBB pattern is seen in electronic right ventricular pacing

26. Left bundle branch block is often a marker of ?
A. Ischemic heart disease
B. Severe aortic valve disease
C. Cardiomyopathy
D. All of the above

27. Examples of bifascicular block include ?
A. RBBB and LPHB
B. RBBB with LAHB
C. Complete LBBB
D. All of the above

Electrocardiography

[MCQ] Electrocardiography- Part 2

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Electrocardiography- Part 2

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